Expandable gastric port for natural orifice translumenal endoscopic surgery

The risk of intraabdominal contamination is a critical consideration during most natural orifice translumenal endoscopic surgery (NOTES) procedures.

The objective of this study was to determine a safe and efficient pathway for the endoscope in a transgastric NOTES procedure.

A pilot experimental study in live pigs was performed.

Five White Landrace pigs, weighing approximately 30-35 kg, underwent the placement of a device consisting of an expandable sheath, the distal portion of which was composed of a fully covered self-expanding metal stent, and an introducer made with an outer catheter, a pushing catheter, and an inner, guiding catheter. The sheath was attached to the stent by suturing it in place. The initial gastric opening was made by means of a needle knife papilotome with electrocoagulation, aimed to the anterior gastric wall. Then, it was dilated with an endoscopic 1.8-cm balloon. The set was introduced over a Savary guidewire. After the set placement, the outer tube was slowly retrieved. Finally, the delivery system was removed from the pig, leaving the entire endoscopic port in place.

The expandable gastric port was placed without difficulty in all animals. Endoscope insertion into the expandable gastric port was very easily performed. The endoscope had a wide range of movement inside the peritoneal cavity. The gastric port sealed the gastric wall, avoiding gross contamination of the peritoneal cavity and maintaining the pneumoperitoneum without excessive inflation of the intestine.

Use of a gastric port can minimize contamination of the peritoneal cavity due to the spillage of gastric contents during a transgastric NOTES procedure and can also facilitate performance of the procedure.